Factors Associated with the Use of Drug-Eluting Stents in Patients Presenting with Acute ST-Segment Elevation Myocardial Infarction

Abstract

Background. Drug-eluting stents (DES) have proven clinical superiority to bare-metal stents (BMS) for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Decision to implant BMS or DES is dependent on the patient's ability to take dual antiplatelet therapy. This study investigated factors associated with DES placement in STEMI patients. Methods. Retrospective analysis was performed on 193 patients who presented with STEMI and were treated with percutaneous coronary intervention at an urban, tertiary care hospital. Independent factors associated with choice of stent type were determined using stepwise multivariate logistic regression. Odds ratio (OR) was used to evaluate factors significantly associated with DES and BMS. Results. 128 received at least one DES, while 65 received BMS. BMS use was more likely in the setting of illicit drug or alcohol abuse ([OR] 0.15, 95% CI 0.05–0.48, p ≤ 0.01), cardiogenic shock (OR 0.26, 95% CI 0.10–0.73, p = 0.01), and larger stent diameter (OR 0.28, 95% CI 0.11–0.68, p ≤ 0.01). Conclusions. In this analysis, BMS implantation was associated with illicit drug or alcohol abuse and presence of cardiogenic shock. This study did not confirm previous observations that non-White race, insurance, or income predicts BMS use.

Rates, predictors and the impact of cannabis misuse on in‐hospital outcomes among patients undergoing percutaneous coronary intervention (from the National Inpatient Sample)

“…In our study, we also observed low rates of drug‐eluting stents among groups with cannabis use. There is evidence that bare‐metal stent use was more prevalent among patients with illicit drug use, and we speculate that this may be related to concerns about adherence to dual antiplatelet therapy postprocedure as failure to take dual antiplatelet therapy may result in stent thrombosis. While there is growing legalisation of marijuana in America, it has been at one point described a gateway to more dangerous illicit drug use .…”

Racial Disparities and Outcomes of Percutaneous Coronary Interventions in Patients Above 65 Years in America: A Systematic Review

“…The findings from these articles collectively demonstrate the existence of racial disparities in access to PCI, door-to-balloon time, procedure utilization, and clinical outcomes among elderly patients in America [ 14 ]. African American and Hispanic patients were consistently found to experience delays in accessing PCI, longer door-to-balloon times, and lower rates of procedure utilization compared to their White counterparts [ 15 ]. Moreover, racial and ethnic minorities had worse clinical outcomes, including higher mortality rates and an increased risk of major adverse cardiovascular events [ 1 - 4 , 10 ].…”

“…Olafiranye et al (2015) observed that African American and Hispanic patients experienced worse outcomes compared to Caucasian patients [1]. These findings suggest that race may play a significant role in influencing long-term safety and efficacy outcomes following PCI, potentially leading to disparities in cardiovascular health among older patients [1,13,[15][16][17][18][19][20][21].…”